Aesthetic Medicine
Aesthetic Medicine


Turn down the volume


Like many of the patients I see in my practice today, I was first attracted to what could be achieved with aesthetic treatments when I started researching them for myself back in 2007, ahead of my upcoming wedding.

At the time, I was working as an advanced nurse practitioner in A&E, having just done my Master’s in Advanced Practice, and the parts of my role which I enjoyed the most were the practical parts. In A&E there were plenty of opportunities for me to work with my hands, suturing and putting drains in, etc. My husband was an NHS hospital consultant and I knew that two of us working shifts wouldn‘t work if we were to have a family. Aesthetics brought together all my interests and it felt like the right time to look at training.


Back when I first started in aesthetics, we didn’t have the conferences and the journals that we have today. We didn’t even have a rep for the major brands for the whole of the North West of England, so you were only really introduced to and guided towards products through your basic training. Dermal fillers are one of the main stays of any aesthetic practice, and lip treatments have continued to grow in popularity since I first started.

Product selection is absolutely key, not only for natural outcomes but also for safety and efficacy. It was always important to me to stick to products from the market leaders that had plenty of clinical data. As my practice grew along with the industry, there was more opportunity for me to look at other products that I became aware of through going to conferences.

I was already using some of the Merz Aesthetics portfolio but the big game changer for me was the introduction of BELOTERO®

Lips Shape 1 and BELOTERO® Lips Contourinto my practice. They really revolutionised the way I market to and treat patients presenting for lip enhancement.

In the past, across most brands, products were only available in 0.5ml or 1ml syringes.

This undoubtedly influenced the industry and our patients. Demands and pricing became focused on volume treatments rather than the individual need of the patient. Patients even started requesting a 0.5ml or 1ml lip treatment, rather than presenting with a desire for a particular improvement or result. 

The BELOTERO® Lips Shape 1 and Lips Contour2  products are presented in a 0.6ml syringe. BELOTERO® Lips Shape1 is perfect for volume enhancement or correcting volume loss in the ageing lip, while BELOTERO® Lips Contour2  is a much more cohesive product, ideal for treatment of the vermillion border and perioral lines.

Over the past couple of years, I have witnessed changing trends –a move away from the over-enhanced lip, an increased desire and demand for natural enhancement and correction of overfilled lips. This pattern has been seen across all age groups, with younger patients seeking a natural enhancement and older patients seeking restoration. This observation, along with the timely launch of the BELOTERO® Lips products, prompted me to change the way I market and deliver lip treatments in my practice, and gave me an opportunity to move away from volume-focused treatments and offer something different.

The Lip Duo treatment was created as an alternative to the 0.5ml or 1ml treatment. Utilising the BELOTERO® Lips Shape 1 and Contour 0.6ml products, I was able to combine the properties of fine line and volumising fillers. This gave me flexibility to treat a range of deficiencies as well as to beautify the central lower face and lips.

Treatments are priced accordingly, slightly more than a 1ml treatment, but also deliver far superior results. Both Lips products benefit from the use of Cohesive Polydensified Matrix® (CPM) technology 3 ,a combination of high and low-density zones that allows BELOTERO® products to “mimic” tissue behaviour.

The low density features of BELOTERO® Lips Contour 2 ensures optimal dermal integration , which makes it ideal for the vermillion border and perioral wrinkles. The cohesivity helps prevent the undesirable migration of product from the vermillion border into the white lip. In contrast, Lips Shape is highly elastic to support tissue with an amazing ability to resist shear stress and return to its original shape. These rheological properties are ideal in a highly dynamic area. A common presentation to an aesthetic clinic is the desire to enhance lip volume and create and improve the lip outline and Cupid’s bow. In addition, in ageing lips, refining perioral wrinkles is also a common request. To treat the presenting concerns, products with varied rheology are required to achieve optimal results. This could be costly for patients and for the clinic, especially if only a small amount of a specific product was required. There has certainly been a temptation to try to make a single product fit the patient’s needs in order to come in on budget, and I have seen the undesirable results of this first hand.


The patient presented to clinic requesting enhancement of the lips. No previous dermal filler treatment had been performed. On assessment, it was clear that enhancing the lips in isolation would not achieve best results. In fact, it was felt that it may even further highlight areas of deficiency. Following a consultation and analysis with the patient, a tailored approach was delivered.



There was volume loss to the upper white lip marionette region and the development of nasolabial folds was creating shadows and uneven transitions. There was also loss of volume and proportion, in particular in the lower lateral lip as well as dynamic perioral lines.


1. To restore volume to the white upper lip and improve contours on the lateral aspects as well as the commonly seen vertical lines of tissue weakness from the oral commissures. 

2. To define the lip border, creating a sharp lip outline and Cupid’s bow. 

3. To improve lip proportion by volumising the lip body, with particular attention to the lower lip. 

4. To improve the nasolabial and marionette region.


BELOTERO® Lips Contour 2 was used in the upper white lip, vermillion border, upper lip body and oral commissures, with a total of 0.6ml used. BELOTERO® Lips Shapewas used in the lower lip, inferior nasolabial lines and marionette region, with a total of 0.6ml.


Using a combination of products enabled me to achieve improvement in multiple areas of the central lower face. The lips have now become a feature of the lower face, with very little product used within them. The treatment of the surrounding areas of deficiency has removed shadows, lifted the tissues and improved contours and transitions, overall, delivering much more than a “lip enhancement” with great economy of product and a reasonable price point for clients.

Additional benefits are the fantastic before and afters achieved. This provides great content to market the Lip Duo Treatment with that is not comparable to a traditional volume lip treatment. Educating patients is also important to understand the potentially undesirable results often seen from using the wrong product in the wrong place. For example, product migration and distortion of the lip outline from the use of a volumising lip filler into the vermillion border.


Product selection plays a key role in providing natural-looking lip- filler treatments. We must start to move away from lip treatments which look unnatural and overdone and towards those that enhance our patients’ features, not overpower them.

Educating your patients about the safety, tolerability, clinical evidence and efficacy of what is being injected into their lips is paramount. The BELOTERO® Lip Duo treatment offers us as nurse practitioners an opportunity to re-educate our patients and to put an end to the culture of them requesting lip fillers by the ml. By using a blend of products, lip filler treatments can be tailored to individual patients for more natural-looking results.

Those looking to gain more knowledge of the products and techniques used to achieve great results in the lip area should take a look at the BELOTERO® Lips Masterclass webinar from The Merz Medical Institute. You can access the webinars at


1. IFU – BELOTERO Lips Shape. 

2. IFU – BELOTERO Lips Contour. 

3. Sundaram & Fagien 2015 Cohesive Polydensified Matirs Hyaluronic Acid for Fine Lines. Plast Recon Surg. 136:149S, 2015

4. Micheels, P. et al. Effect of Different Crosslinking Technologies on Hyaluronic Acid Behavior:

A Visual and Microscopic Study of Seven Hyaluronic Acid Gels. J Drugs Dermatol. 2016 May 1;15(5):600-6

M-BEL-UKI-0963 Date of Preparation January 2021 This advertorial is sponsored by Merz Aesthetics UK & Ireland

For more information visit, @merzaesthetics.uki on Instagram or Merz Aesthetics UK & Ireland on Facebook

This article appears in the July/August 2021 Issue of Aesthetic Medicine

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This article appears in the July/August 2021 Issue of Aesthetic Medicine